Adverse work conditions may be to blame for the decline in the number of primary care physicians nationwide, according to a study published in the latest issue of the Annals of Internal Medicine.

"Unfavorable work conditions are associated with stress, burnout, and intent to leave for primary care physicians," said Dr. Anita Varkey, study author and assistant professor in the department of medicine, Loyola University Chicago Stritch School of Medicine. "These factors contribute to poor job satisfaction, which is among the reasons we are seeing a decrease in the number of primary care physicians."

The Association of American Medical Colleges estimates that the overall shortage of doctors may grow to 124,400 by 2025.

"There are not enough primary care physicians to meet current needs," Varkey said. "These findings suggest that a chaotic clinic environment may further exacerbate this problem and potentially lead to lower quality of patient care due to physician turnover and lack of continuity in care."

Data for this study were collected from 422 family practitioners and general internists and 1,795 of their adult patients with diabetes, hypertension, or heart failure at 119 clinics in New York and the Midwest. Study participants were asked about perception of clinic workflow (time pressure and pace), work control, organizational culture, physician satisfaction, stress, burnout, and intent to leave practice.

More than half of the physicians, 53.1 percent, reported time pressure during office visits, 48.1 percent said their work pace was chaotic, 78.4 percent noted low control over their work, and 26.5 percent reported burnout. Adverse workflow (time pressure and chaotic environments), low work control and unfavorable organizational culture were strongly associated with low physician satisfaction, high stress, burnout, and intent to leave. Some work conditions also were associated with lower quality of patient care and more errors, but findings were inconsistent across work conditions and medical diagnoses.

The authors indicated that interventions in primary care clinics should target measures to reduce physician burnout, clinic chaos, and work control measures. A healthier workplace for physicians may result in better recruitment and retention of primary care physicians, which may then translate to higher quality patient care.

"While further research is needed, health care reform strategies should consider the role that work environment plays in physician job satisfaction and quality of patient care," Varkey added.

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